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Medical science is continually making advances with the development and introduction of new medications and treatments. But the major surgical advancement that has taken place in the last 10 years is minimally invasive surgery, also known as laparoscopic surgery or keyhole surgery. In minimally invasive surgery, surgeons use a variety of techniques to operate, with less injury to the body than with open surgery as major operations are done through a tiny incision. The advantage to the patient is that there is less stress on the body, according to General Surgeon Dr. Ross Downes.
"You recover faster, you have less pain ... You do better. [Minimally invasive surgery] is something that's become widely adopted ... It's spread like wildfire," said Downes, who spoke at the recent Doctors Hospital Distinguished Lecture Series. "A lot of people have adopted these techniques because they see the value in them. And the reason they're being able to make such advancements is because of how society has advanced -- a lot of things that were once science fiction are now reality."
Case in point, the doctor who refers to himself as a "science geek" is looking forward to the first commercial flying car -- an idea he said people should not consider far-fetched.
"We remember 'Star Trek' [and] Captain Kirk's communicator, many people have an iPhone, very popular device. Captain Picard had his handheld computer -- the iPad is very commonplace to us. The same thing has happened to medicine -- there is no difference. Doc if you remember him with his tricorder, flashing that little silver device over the patient and getting all the information he could. Today we have similar devices, a handheld ultrasound called a Vscan that can give us a whole bunch of information -- so not only can I talk to you and get information, I can examine you, and then I can do an ultrasound by the bedside."
Advancements in minimally invasive surgery are in all different areas of surgery -- urology (operation of the kidneys, the bladder and the tubes that connect them); gynecology; orthopedics (operation of the bone); neurosurgery (operation of the brain and spine); and of course general surgery.
Medical versus surgical advances
According to Downes, one of the major medical advances has been the 2000 Human Genome Project, in which scientists looked at human DNA and were able to tell exactly what each piece of DNA could do.
"The aim of the project was to use it to create new drugs," said the doctor. "In the last 20 years there haven't been that many new drugs, but what they're trying to do is get a new angle by using your genes, your genetic material, your DNA and create a drug that is targeted so that so you get a better faster and more directed outcome. Diabetes is very common in our society. You can't really solve diabetes, but if you can treat it better, if you can diagnose it earlier, then patients do better. We're able to use a lot of materials to help fix bones. Back in the day we were very limited with what we could use, but now with us using the Human Genome Project, printing what the DNA is, we're able to produce materials that the body does not reject, so it doesn't have to be a foreign material. It's something that your body can accept. And because it's tailored to your body, your body accepts it and it forms new bone for you."
Medical science is also developing technology to enable patients to take their ECG and vital signs at home, and send the information to their doctors.
Biosensors, which Dr. Downes said are relatively new, have exploded in use around the world. The tiny, flat device that is the size of a postage stamp is placed on the body and monitors a patient's vital signs daily, hourly and minute-to-minute. The results can then be shared with physicians, and the patient can log on to a computer and see his or her results, said the general surgeon.
As the technology for imaging devices advances, the CT Scan and MRI machine have also progressed to the point at which they can hone in on a specific organ in the body. The doctor compared the technology to taking the organ out of the body and putting it on the table.
Advances, he said, have also reduced the number of times insulin takers need to test their blood sugar levels on a daily basis.
"We put a little monitor on the belly and then you have a pump connected with a needle that goes into the skin of the abdomen, and what this monitor does is senses what your glucose levels are. It senses those glucose levels, and then tells the device how much insulin to give you," said the general surgeon.
Advances also include the Wello cellphone case, which gives vital signs --how fast a person's heart is beating, how fast he or she is breathing, temperature and seeing how well his or her organs are being oxygenated.
"Everybody has a cellphone, so you put this case on your cellphone and from anywhere you can get this information, this information not only you can use, but you can now sign up with services, connect with your doctor, and send that information to him," said Downes. "So once you don't feel well, or you do this on a regular basis, you can have this information, send it to your doctor and your doctor can create trends." The iWatch would do the same thing.
The office visit of the future would involve patient portals, allowing patients to sit in front of a computer and connect with a physician. Limitations may include acute conditions.
"But if we know what you have and we know what your conditions are, and we can combine them with the information that we got from all of those sensors, then we can figure out what's going on with you, and again from the comfort of your home we can tell you what's going on."
Advances in urology include the uroscopy. Instead of getting big cuts to look at one of the most common problems - ureteric stones, or stones of the kidney tract - physicians can do minimally invasive surgery. Back in the day, surgeons would have to cut open the kidney or the urethra, to get the stone out, something they no longer have to do.
When doing a transurethral resection of the prostate, instead of cutting, surgeons can now go through the urethra (the urinary hole) and shave some of the prostate to allow men to pass urine. Other techniques include transurethral microwave thermal technology in which microwave is used to burn the prostate with a special microwave device. Minimally invasive procedures are done when cancer is not present.
Gynecology is the specialty that first employed a lot of the laparoscopic techniques. A wide range of conditions can be treated through minimally invasive surgery, including cysts on ovaries; tumors and cancers; ectopic pregnancies (pregnancies in the wrong places); pelvic infections; endometriosis (abnormal tissue deposits from the womb in the abdomen which can cause problems) and pelvic adhesive disease.
According to Downes, doctors are now able to operate on more joints using minimally invasive techniques, including the shoulder, the knee and the hip.
"All we do is make three little tiny holes, one is a camera. We look at the joint, find where those problems are, and are able to shave cartilage that is in the wrong place; we're able to look at tears in the tissues of the joints and fix those. And we can do that without getting a big incision that used to traditionally cause you to have a lot of problems, as well as be in hospital for extended times."
Spinal surgery is another advancement that he said has been made. Back in the day spine patients had to get long cuts along their spine for medical practitioners to fix problems, especially when they were at multiple levels.
In general surgery, removal of the gallbladder was one of the first advancements that they saw in general surgery. Minimally invasive surgery he said has allowed for people to no longer have to get that centipede cut on their belly to have their gallbladder removed, or have to ingest the nasty tasting liquid in hopes that the stones would dissolve. Gallbladder surgery, he said, can now be done laparoscopically through four tiny holes and the gallbladder taken out without a problem.
In 2004 at Doctors Hospital, 32 patients had gallbladder surgery using minimally invasive surgery, in an average time of 38 minutes per surgery. The total number of gallbladders removed numbered at 100. Dr. Downes said they still do open surgery to remove gallbladders because they are forced to, but that the overwhelming majority of cases that are complicated with stones in their ducts get an ERCP (endoscopic retrograde cholangiopancreatography). He said doctors found that they had better outcomes using ERCP and that patients went home in just over a day as compared to two to three days if they had open surgery.
Of the 78 appendectomies performed that year at Doctors Hospital, 38 were done laparoscopically, and the patients showed better outcomes and less operative time. The average operating time was 22 minutes.
The general surgeon said they have also done seven colectomies, three done in the single port laparoscopic group. The rest were done with traditional laparoscopy; they've done liver resections, at least one splenectomy every six months, using the single port technique.
Dr. Downes said that the next stage in evolution is single port laparoscopy and the ability to do all surgeries through one little tiny hole in the belly button.
Hernias are also now being repaired using minimally invasive surgery with a little cut by the belly button, and two little cuts on the side. They no longer need to do the big cut on the belly to fix hernias. Because of the equipment that is required for the procedure, Dr. Downes said The Bahamas is still not at the point in time where they can perform minimally invasive surgery on everyone. It is only done in special cases -- if a person has hernias on both sides, a hernia that was fixed before and came back, or an athlete who needs to get their feet fixed quickly. Bowel resection surgery he said is advantageous minimally invasive because all surgeons have to do is be able manipulate it, cut it out and put it back together.
Dr. Downes said minimally invasive surgery is also advantageous with bariatric surgery, which is essentially weight-loss surgery. He said extra weight on a person makes it difficult to perform surgeries, as the patient is at risk for a number of complications. With laparoscopic surgery he said they are able to reduce the complications while giving the patient the benefit of treating their obesity. According to the general surgeon, nine procedures using laparoscopy was done last year at Doctors Hospital, even though he knows there are many more that need the surgery.
Natural orifice translumenal endoscopic surgery (NOTES) he said is another advancement that medical evolution has seen, but which hasn't really caught on as it takes a high level of expertise to perform. A hole is made in the patient's intestine -- usually the stomach, or the vagina, according to Dr. Downes, and they're able to go into the abdominal cavity and do surgery. But he said the surgery involves specialized expensive equipment.
"In 2000 they started seeing us doing this kind of procedure for people who had reflux, and then they decided if we can do it inside the stomach, inside the intestine, why can't we go through the intestine and do something outside. In 2004 in India, they decided they would go through the stomach and take out the gallbladder, and they would go through the vagina and take out the appendix, and then they decided to do it the other way -- they went through the stomach and took out the appendix, and went through the vagina and took out the gallbladder. Initially when they started to do those things they had a lot of complications, as expected. If you make a hole in the stomach for no reason it can leak, so with the advances that they've done, this is something that they're trying to push a little more, so this is a true version of scar-less surgery. There is no scar that can be seen on the body."
Dr. Downes said medical practitioners are also now employing robotics. When the robot first came on it was done in the tradition of laparoscopy with multiple holes, but they've married the ideas, so they now use the robot and they also have single port access. He says robots also allow a doctor who may have a fine tremor to eliminate the errors.
"The good thing about it is it almost mimics the natural hands. The robot allows us to do this and it's almost like we're doing surgery with our natural hands. It's faster surgery and more precise."
With the 22nd century approaching, Dr. Downes said medical evolution in The Bahamas needs to keep abreast of the advancements, but he said in The Bahamas, the robot is something that is probably not achievable right now as it costs more than $1 million to purchase the robot and $150,000 a year to maintain. "It [robot] might not be appropriate for our environment, but certainly, a lot of these other advances are things we should be implementing today," he said.
The body is like an orchestra -- in order to get the best music -- all sections must be functioning at an optimum level according to Dr. Sy Pierre, the most recent medical professional to speak at the monthly Doctors Hospital Distinguished Lecture Series.
The anesthesiologist spoke on advances being made in anti-aging treatments and the treatment of degenerative diseases. He shed light on detoxification, diet, exercise and dietary supplementation, as well as bio-energy medicine, bio-oxidative medicine and bio-molecular medicine.
He told people that filled the hospital's conference room that no matter how many hormones someone pumps into a person, if their general health is not good, that it would not make any difference. And that the goal of medical professionals is really the prevention and treatment of the chronic, degenerative diseases that are at epidemic proportions.
With so many names -- anti-aging medicine, interventional endocrinology, orthomolecular medicine, functional medicine, allopathic medicine, alternative medicine, holistic medicine and integrative medicine -- Dr. Pierre said no matter what it's called, it all means one thing, the provision of the correct substance for the correct disease at the correct time with the goal being the prevention and treatment of chronic degenerative diseases.
Chronic degenerative diseases include cancer, heart and blood vessel disease, diabetes, hypthyroidism, hormonal dysfunction, menopause, andropause (male menopause) and other endocrine diseases, arthritis, multiple sclerosis, lupus, Chron's disease, ulcerative colitis, autism, Alzheimer's, Parkinson's disease and other neurodegenerative diseases.
According to Dr. Pierre, The Bahamas is in the midst of an inflammatory crisis. In a graph he showed his audience what medical experts consider should be normal aging -- a person's birth, leveling off between ages 25 and 35, then going rapidly down to pass on to the afterlife between age 75 and 80. But he said what they're seeing now is people who are healthy a lot shorter than the average -- people attaining the age of 21-25 remaining healthy for a few years and then declining chronically, starting with hypertension, diabetes, arthritis and eventually cancer and some other disease.
He said with a disease like diabetes, at one time medical professionals used to break it down into juvenile diabetes and adult onset diabetes; but now it's so common early on that medical professionals just call it diabetes.
"We are in the midst of an inflammatory crisis," said Dr. Pierre.
Causing all of the inflammation, he said, is the presence of reactive oxygen molecules or free radicals; poor diet and lack of proper supplementation; lack of exercise; toxic personal care products; environmental toxins and electrical pollution, among other causes.
Free radicals or reactive oxygen species (ROS) are produced normally in humans as byproduct of oxygen utilization for energy. Normal amounts are essential for destruction of microbes, detoxification and excretion of toxins. Excessive amounts are dangerous.
"Reactive oxygen species are produced normally by humans or most animals that utilize oxygen for energy. And they actually have a good purpose as most things that we produce do and don't get rid off," said Dr. Pierre. "You produce them to fight increasing amounts of environmental toxins. But in excessive amounts he said they start attacking themselves and result in autoimmune diseases.
"When the immune system is attacked by these free radicals you get diseases such as Lupus, Multiple Sclerosis, arthritis, Chron's disease, inflammatory bowel disease and eventually cancer. If the endocrine system is attacked you see things such as diabetes, thyroid disease, ovarian cyst, endometriosis. Heart and blood vessel attacks result in hypertension, heart attacks and eventually strokes. Neurological problems include autism, Alzheimer's, Parkinson's and other diseases."
Poor Bahamian diet
According to Dr. Pierre, the Bahamian diet -- one that's rich in sugar, processed carbohydrates, and unfermented dairy products - is a huge problem. He said the diet causes Hyperinsulinemia or Dysmetabolic Syndrome X, Gut Dysbiosis, Leaky Gut Syndrome and GERD.
"When you take large amounts of sugar and carbohydrate, the body responds by producing insulin, an androgenic or growth hormone. It's like a drug ... A heroin or cocaine addict is always trying to achieve that first high, but your body always responds in a way to say I'm not going to let it do it, so you take more sugar but you need more sugar to get the same effect, because your body is resisting it. In addition to driving sugar into the cells, insulin also creates plaque around your arteries and blood vessels. It also creates inflammation in the pelvis."
Dr. Pierre said people plagued with endometriosis and pelvic inflammatory disease should have their fasting insulin measured.
He told his audience that everyone has more bacteria and other microbes in their bowel than they have cells in their entire bodies and that they are good and bad but usually there is a balance. He said when a person takes in excessive amounts of sugar it feeds yeast like Candida, the abnormal bacteria and they get an overgrowth. The overgrowth, he added, creates tears in the bowel that allow "stuff" to leak into the blood stream, resulting in what is called Gut Dysbiosis.
"Because you're getting all these abnormal substances getting introduced into the body, your immune (system) sees it and attacks it; so now you have the autoimmune disease and now the body becomes mixed up. It does not know what is self and what is non-self so in addition to attacking these molecules, it attacks the blood vessels, kidneys, pancreas --you get diabetes."
One of the best forms of defense is offense, according to the doctor who said that exercise is important to increase oxygenation for immune system stimulation and detoxification.
"We all need to sweat. Sweat is probably one of the best methods of detoxification," he said.
While you get your sweat on, he said sensible sun exposure should also be taken into account because without sun exposure you miss the all-important Vitamin D, a hormone that he said most people are deficient in
"Black Bahamians in particular avoid the sun like the plague, but what is terrible is that the darker you are probably the more you need to be in the sun. Someone from Scandinavia who has red hair, freckles, blue eyes ... they can go out in the sun for 15 minutes and start to burn. There is a reason for that. Their skin is fair because of where they're descended from. They don't get a lot of sunshine so they need to absorb sun quickly whenever it is there. If obviously you're descendant from somewhere along the equator your skin needs to be darker to protect you from the sun, and so therefore the darker you are the more you need to be in the sun, and our people don't like to go in the sun," he said. According to Dr. Pierre, being in the sun is also a good method of detoxification, as it allows for sweating.
Personal care product alert
The doctor also urged people, especially women to be aware of the many personal care products they use in terms of toxicity.
"I usually say I think of a female in the morning getting dressed -- she may use shampoo, conditioner, she has hair color, relaxers, if they have weave some of them are using glue, one of the most toxic things known to man, mascara, eyeliner, lipstick, gloss, facial creams, lotion, perfume, deodorant, nail polish, toothpaste, mouthwash, shaving cream, soap, dental amalgams (fillings), all of these things contain small amounts of lead, arsenic, mercury, aluminum, lead, iron, PCBs, petroleum distillates, things that are very toxic. What we have to understand is that fat tissue and in particular breast tissue is used as a toxic depot. When your body can't deal with substances it goes into these lymph nodes. Once they go into there and into the breast tissue if the body can't deal with it right then, it kind of pushes it and stays in the breast tissue until you sweat it or it leaks out slowly. When you have all of these substances going into your breast tissue it's no wonder breast cancer is so high," said Dr. Pierre.
"Any of these substances by themselves are probably not that bad, but once you start adding five, 10, 15, 20 substances, for five, 10, 15, 20 years of your life, your diet is poor, you don't exercise, you don't sweat, I'm surprised that the rate of breast cancer isn't higher. And it will go higher if we don't stop," he said.
As far as environmental toxins, Dr. Pierre says there isn't much that can be done about it because those toxins are in the air.
As for the diet, Dr. Pierre's advise is that people eat 60 percent raw or minimally cooked vegetables; 20 percent protein in some form whether eggs, meat, chicken or seafood; 10 percent nuts and about 10 percent fruits.
"A lot of people fool themselves and say I eat a lot of fruit so I'm healthy, fruit has a lot of sugar -- if you eat a lot of sugar you're going to secrete a lot of insulin and you cause all those bad things. Like anything else, too much of any one thing is no good. It's better to eat more vegetables than fruit," he said.
He endorses moderate exercise and said people should take advantage of walks on the beach that would also allow them to get sensible sun exposure.
And he told them to search out non-toxic personal care products, substances like baking soda which he said is a good deodorant and antiperspirant, toothpaste and foot powder.
Getting rid of toxins
Sweating to detoxify is the best way to rid the body of toxins as are coffee enemas and colonics, according to Dr. Pierre. He said an old therapy Pulse Electro Magnetic Field (PEMF) Therapy is coming back again. The therapy sends different waves of energy to the cells that are not functioning and kinds of shocks them back into functioning normally. He said if a person has cells of their pancreas that are not functioning properly and they have PEMF, they may be able to decrease the amount of insulin that they have to take. Or that if they have arthritis or joint issues and pain and they get their collagen and all their substances and their cells start to work properly again, they may have less joint pain and actually be more mobile.
He said oxidative medicine are more cutting edge unique therapies like the use of hyperbaric oxygen chambers and pushing pure ozone into cells of the body to increase oxygenation to decrease toxins and help the body to function a lot better. He said these treatments are good for people with hypertension, high cholesterol, diabetes, joint pain and arthritis.
Bio-identical hormone therapy
In biomolecular medicine a physician writes a prescription, but according to Dr. Pierre, what they are now trying to do is use more normal or natural occurring substances.
"If someone has a flu you can give them a high dose -- 50, 100, 200 grams of Vitamin C intravenously into their veins. This is a normal substance, it won't cause any problems and it will cure them over a day or two, especially for colds, flus. Substances like Vitamin C, high dose B vitamins, magnesium, zinc, these things are things are what our bodies lack and may be the reason for us getting the infection in the first place," he said.
In bio-identical hormone replacement therapy, hormones that are identical to those that the body produces and treat that are low or absent in bodies are replaced. It is the same principle used in diabetes when the pancreas does not produce sufficient insulin.
"You're giving your body something that is now gone to the point where it cannot produce it in sufficient amounts any longer."
Depending on the hormone replaced, the medicine may be taken by mouth, may be used as a cream or get that is rubbed on the skin, or by the injection of a small amount of medicine under the skin a few times a week.
Primary replacement hormones include thyroid hormone, cortisol, estrogen, progesterone and pregnenolone, testosterone, growth hormone, DHEA and melatonin.
According to Dr. Pierre, without a proper amount of thyroid hormone no other hormone or system works in the body.
"We all need adequate amounts of thyroid hormone. With deficiency you see decreased energy, chronic fatigue, early morning fatigue, decreased mental acuity, depression, weight gain, hair loss at the outer eyebrows, muscle joints, aches and pains, fibromyalgia, constipation and high cholesterol."
Progesterone deficiency in women he said causes early menopause. He said it's not so much the progesterone deficiency, but the fact that it's out of balance. Women he said suffer with insomnia, anxiety, panic attacks, mood swings, breast soreness, bowel changes, hot flashes, fibrocystic disease, ovarian cysts, abnormal uterine bleeding. He said progesterone deficiency in men isn't seen much, but if it does, it can cause sleep disturbances and anxiety.
Dr. Pierre said progesterone deficiency starts in the mid-30s, while estrogen deficiency starts later in life in the 50s and 60s. But he said if a person is replacing estrogen, they must also take progesterone as well.
"They must be used together [as] estrogen by itself will probably increase your rate of cancer."
Estrogen deficiency in men he said usually results in osteoporosis and bone loss. In women the results are hot flashes, night sweats, depression, dry, wrinkled and cracked skin, especially of the face, headaches, bone loss, vaginal dryness, recurrent urinary tract infections, strokes, heart attacks and cancer.
The primary anti-inflammatory
According to Dr. Pierre people have to have Cortisol, the primary anti-inflammatory of the body which is produced by the adrenal gland which has the richest store of Vitamin C in any organ of the body.
"If people are deficient [in Cortisol] they may have multiple chemical sensitivities, allergies, joint and muscle pains, loss of muscle and bone, high cholesterol, sugar and salt craving."
As people hit their 70s, Dr. Pierre said patients undergoing orthopedic surgery should look into having growth hormone therapy to make their surgical procedure a lot less likely to have side effects.
Growth hormone is a big player in all connective tissue such as bone, muscle, fat and any other connective tissue. It optimizes a person's immune function and is a good thing to replace if it's low according to the doctor. He said maximally it takes four to six weeks to start working so if a person needs surgery, they should speak to their surgeon a few weeks prior to their surgery.
DHEA (dehydroepiandrosterone) he said is the most abundant hormone in the body. When it's low he said people have a decreased sex drive, have frequent upper respiratory track infections, colds and flus, decreased body hair, weight gain and osteoporosis.
He said melatonin decrease is usually seen in older people who sometimes have difficulty sleeping and wake in the middle of the night. He said melatonin replacement may actually alleviate the problem and should not cause any side effects if used in normal doses.
o Dr. Pierre described HCG (Human Chorionic Gonadotropin) as the new wave hormone that is now sold for weight loss. HCG is produced naturally in humans. It's replacement is usually given by injecting a small amount of the liquid under the skin of the arm, leg or thigh, two to three times per week. HCGT is used to treat weight management challenges in men and women. It is also used to treat male menopause or andropause. But he cautioned that if it is being used that HCG should be supervised by a physician who is familiar with its use.
Clubfoot describes a range of foot abnormalities that children can be born with. A baby's foot is twisted inward and is out of shape or position. With clubfoot, the tendons (tissues that connect muscles to the bone) are shorter and tighter than usual, pulling the foot in this abnormal position. The term 'clubfoot' refers to the way the foot is shaped, like the head of a golf club. Clubfoot is a fairly common birth defect and is usually an isolated problem in an otherwise healthy newborn. Clubfoot can be mild or severe. About half of children with clubfoot have it in both feet.
If your child has clubfoot, his or her foot may have the following appearance:
o The top of the foot is usually twisted downward and inward, increasing the arch and turning the heel inward;
o The foot may be turned so severely that it actually looks like a backward C or even upside down;
o The calf muscle in that leg is usually small or underdeveloped;
o Because of the curve, the clubbed foot may be up to a 1/2 inch (about 1 centimeter) shorter than the other foot.
More than likely your pediatrician will notice the clubfoot soon after your child is born.
The cause of clubfoot is unknown. But scientists do know that clubfoot is not caused by the position of the baby in the womb during pregnancy. In some cases, clubfoot can be associated with other abnormalities that are present at birth, such as spina bifida (a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube). Studies have linked clubfoot to cigarette smoking during pregnancy, especially when there already is a family history of clubfoot.
Risk factors include sex.
Clubfoot is more common in males.
o Family history: If either one of the parents or their other children have had clubfoot, the baby is more likely to have it as well. It's also more common if the baby has another birth defect;
o Smoking during pregnancy: If a woman with a family history of clubfoot smokes during pregnancy, her baby's risk of the condition may be 20 times greater than average;
o Not enough amniotic fluid during pregnancy: Too little of the fluid that surrounds the baby in the womb may increase the risk of clubfoot;
o Getting an infection or using illicit drugs during pregnancy. These can increase the risk of clubfoot as well.
Despite how the foot looks, clubfoot is not usually painful. If your child has clubfoot, it will make it hard for him or her to walk normally. He or she may have some difficulty with finding shoes due to shoe size. The affected foot may be up to one-and-a-half foot shoe sizes smaller than the unaffected foot. However, if not treated, clubfoot causes more serious problems. These can include:
o Arthritis: Your child is likely to develop arthritis;
o Poor self image: The unusual appearance of the foot may make your child's body image a concern during the teen years;
o Inability to walk normally: The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases;
o Muscle development problems: These walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the feet and result in an awkward gait.
Most commonly, a doctor recognizes clubfoot soon after birth just from looking at the shape and positioning of the newborn's feet. Occasionally, the doctor may request X-rays to fully understand how severe the clubfoot is, but usually X-rays are not necessary.
It's possible to clearly see some cases of clubfoot even before birth during a baby's ultrasound examination. If clubfoot affects both feet, it's more likely to be seen in an ultrasound. While nothing can be done before birth to solve the problem, knowing about the condition may give you time to learn more about clubfoot and get in touch with appropriate health experts, such as a genetic counselor or an orthopedic surgeon.
Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities. Treatment options include stretching, bracing and maybe even surgery.
Stretching and casting (Ponseti method) is the most common treatment for clubfoot. The doctor will do the following:
o Move the baby's foot into a correct position and then place it in a cast to hold it in that position;
o Reposition and recast the baby's foot once or twice a week for several months;
o Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this process.
After the shape of the foot is realigned, parents will need to maintain it by doing one or more of the following:
o Doing stretching exercises with your baby;
o Ensure your child wears special shoes and braces;
o Ensure your child wears the shoes and braces as long as needed -- usually full-time for three months, and then at night for up to three years. For this method to be successful, you'll need to apply the braces according to your doctor's directions so that the foot doesn't return to its original position. The main reason that this procedure sometimes doesn't work is because the braces are not used constantly or for as long as needed.
Stretching and taping (French method) is another method of stretching the foot to help straighten it. Usually this is ordered by the doctor and carried out by the physical therapist and parents. It is done by moving the foot daily and holding it in position with adhesive tape, or by using a machine to continuously move the baby's foot while he or she sleeps. After two months, treatment is cut back to three times a week until the baby is six months old. Once the shape is corrected, daily exercises must be continued along with use of night splints until the baby is of walking age.
Doctors are usually able to treat clubfoot successfully, though sometimes a small number of children may need surgery if clubfoot is severe or doesn't respond to nonsurgical treatments. The tendons will need to be lengthened to help ease the foot into a better position. After surgery your child will be in a cast for up to two months and then need to wear a brace for a year or so to prevent the clubfoot from coming back. Even with treatment, clubfoot may not be totally correctable. But in most cases, babies who are treated early grow up to wear ordinary shoes and lead normal, active lives without pain.
o For more information or if you think your child may have clubfoot, visit www.apma.org or www.mayoclinic.com or email us at Foothealth242@gmail.com. To see a podiatrist visit Bahamas Foot Centre on Rosetta Street or call 325-2996 for an appointment or Bahamas Surgical Associates on Albury Lane or call 394-5820/4 for an appointment.